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Biomedical subjects

L Bastian

Publications and source records attributed to L Bastian.

At least 19 recordsLinked to original sources
PubMed2006

Benign giant cell tumor of the spine: an unusual indication for radiotherapy.

INTRODUCTION: Giant cell tumors are rare primary bone tumors. Multicentricity as well as spinal localization is extremely rare. CASE REPORT: We report about a 64-year-old female patient presenting with history of three osseous and one pulmonal manifestation of a benign giant cell tumor that have manifested metachronously within 23 years. The two periphery bone and the one pulmonal manifestation were treated surgically with success. Now, a further osseous lesion occurred at the seventh vertebra of the thoracic spine and was treated by dorsal instrumentation and replacement of the seventh vertebra. Nine months later, local recurrence of this benign giant cell tumor developed at the thoracic spine and was treated with radiotherapy with a total dose of 45 Gy. Three months after salvage radiotherapy definite local progress occurred localized within the former radiation treatment field. Due to neurological deficits a laminectomy and a stabilization of the destroyed sixth vertebra with bone cement was carried out. Histopathological examination again showed benign giant cell tumor without suspicion of malignancy. CONCLUSION: In the literature the use of radiation therapy remains an appropriate therapy option in benign giant cell tumors with minimal adverse sequelae if primary surgical treatment is not feasible or fails. In cases of definitive radiotherapy a total dose > 45 Gy should be discussed.

Female↗
PubMed2006

[Titanium vertebral body replacement of adjustable size. A prospective clinical trial].

OBJECTIVE: The reconstruction of the anterior column of the thoracolumbar spine is still controversial. METHODS: The clinical notes and radiographs of 50 consecutive patients (29 M, 21 F, 43 years) treated with the Synex implant were reviewed at operation and at 12 and 20 months postoperatively. RESULTS: Of 45 patients, 25 returned to pre-injury activities within 1 year and 29 of 39 within 20 months. Two-thirds of the patients who were followed up returned to their job. After 1 year 25 of 45 patients had no or mild limitations in their back function. Six months later this group decreased to 6 of 39 patients. Visual analog scale (VAS) decreased from 87/100 preoperatively to 65/100 at the 1-year follow-up. The average permanent reduction of the injured vertebrae was 16.9 degrees including 2.3 degrees loss of correction. CONCLUSION: After reconstruction of the anterior column with the Synex implant only a minimal loss of correction or reduction was observed. The clinical outcome after use of the Synex implant appears promising. We recommend this implant as a valuable alternative for reconstruction of the anterior column of the thoracolumbar spine. However, long-term results are still required.

Accidental Falls↗
PubMed2005

Femoral avulsion fracture of the posterior cruciate ligament in association with a rupture of the popliteal artery in a 9-year-old boy: a case report.

Ruptures of the posterior cruciate ligament (PCL) and especially proximal bony avulsion fractures in children are very rare. This in combination with a rupture of the popliteal artery is extremely rare. Thus, an exact incidence is not available from the literature. Overall, these injuries are severe and often lead to chronic knee instability. We report a case of a 9-year-old boy who suffered a traumatic displacement of the left knee with a rupture of the popliteal artery. Prior to transfer to our department, he was treated by a saphenous vein bypass graft and by a transfixation of the knee using two oblique percutaneous pins. We performed magnetic resonance imaging (MRI) scan of the knee which revealed a femoral avulsion fracture of the PCL. Other ligaments and menisci were intact. A transosseous femoral fixation using non-absorbable stitches was carried out. A 1-year follow-up after surgery demonstrates intact peripheral perfusion and sensation, straight axes of both legs and a physiological gait. Minimal differences of the length and circumference of both legs could be measured. The posterior laxity (Lachman-test) was about 5/8 mm (right/left knee) and 2/5 mm (right/left knee) in 90 degrees flexion. The range of motion (extension/flexion) was 5/0/140 degrees -/5/100 degrees (right-left knee). Intact cruciate ligaments were confirmed by MRI. Minimal experience exists in treatment of combined injuries to the PCL and the popliteal artery in children.

Bone Nails↗
PubMed2005

[Ankylosing spondylitis. Therapy and complications of 34 spine fractures].

BACKGROUND: Spine fractures in ankylosing spondylitis (AS) are extremely unstable and associated with a high complication rate. The aim of this retrospective study was to evaluate the therapy and complications of these fractures in AS for a better understanding and management. PATIENTS AND METHODS: A total of 32 patients with 34 traumatic spine fractures were treated from 1981 to 2002. Cause of trauma, fracture site, and neurological examination were assessed. Analyses of the management of the treatment and complications were performed. RESULTS: Banal traumas resulted mostly in spinal fractures at the C 5/6 and C 6/7 level. Two patients were treated conservatively, while the others were stabilized operatively. Before therapy was undertaken, six patients suffered from a cervical radiculopathy, ten patients had an incomplete and two a complete paraplegia. After therapy, neurological status improved in eight patients, but one had a deterioration of neurological symptoms. CONCLUSIONS: Dorsal or combined dorsoventral stabilization of these fractures is necessary for better mobilization of these patients and to avoid further complications.

Adult↗
PubMed2005

[Operative management of cervical spine injuries in patients with Bechterew's disease].

Cervical spinal injuries in patients with ankylosing spondylitis are complex in their nature and management. This condition is associated with a high risk of dislocation and neurological impairment related to osseous instability due to almost absent compensatory mechanisms of the adjacent vertebral segments. Multilevel stabilization and dorsoventral instrumentation is usually required. We report on two patients suffering from ankylosing spondylitis who presented at our institute with cervical spine injuries in whom primary treatment had consisted of single-site stabilization which resulted in secondary fracture dislocation and implant failure. Secondary management by combined dorsoventral stabilization resulted in more rigid fixation and uneventful healing in both cases. We recommend careful assessment and well-planned management in these cases.

Aged↗
PubMed2005

[Compound osteosynthesis as treatment for an osteoporotic LWK-1 burst fracture in a 76 year old female patient].

The surgical treatment of osteoporotic vertebral compression fractures is rarely necessary and is mostly done in fractures with neurological deficit. We present a case of compound osteosynthesis in an osteoporotic fracture of the first lumbar vertebra as a "salvage procedure" after a dislocation of a dorsal internal fixator in a 76 year old female sustaining incomplete paraplegia. In this case, an additional ventral stabilization using a vertebral body replacement was not practicable because of old age and previous pneumonia. We performed an additional compound osteosynthesis using bone cement because of insufficient stability when only using cement for augmentation of the pedicle screws.

Aged↗
PubMed2004

[Reosteosynthesis in dens pseudarthrosis. Case report and review of the literature].

According to general recommendations, unstable nonunions of the odontoid are treated by posterior fusion of the segments C1/C2 and transarticular screwosteosynthesis. The aim of the surgical procedure is to obtain secure reduction stabilization, and fusion of the nonunion. We present a case of secondary atlanto-axial instability treatment following of an odontoid nonunion. In this situation stability of C1/C2 was achieved by atlanto-axial fusion by transarticular screw fixation. The ventral parts of the broken implants were left in place. Diagnosis, treatment and complications of pseudarthrosis of the dens axis are discussed in the context of this case and of literature.

Bone Screws↗
PubMed2004

[Osteosarcoma of the pelvisTwo case reports and review of the literature].

Primary malignant neoplasms of the bone are rare. One of the most common bone tumors is osteosarcoma, most often localized in the metaphysis of adolescent long bones. The sacrum is concerned in only about 1%. Primary bone sarcomas of the pelvis are usually recognized after they have grown to a considerable size. Osteosarcoma patients from Germany, Austria, and Switzerland are treated by neoadjuvant chemotherapy combined with complete surgical excision according to the Cooperative Osteosarcoma Study Group (COSS). Based on a review of the literature, diagnosis, treatment, and complications of two cases of sacrum osteosarcoma are introduced.

Adult↗
PubMed2004

[Surgical treatment of osseous metastases of the pelvis].

Metastases are the most frequent malignant tumors of the skeleton. Breast cancer is the most frequent primary tumor with osseous metastases followed by renal cell carcinomas, bronchial carcinomas, and thyroid tumors. The predominant localization of bone metastases is the spine, followed by the pelvis, femur, ribs, skull, sternum, and humerus. The overall incidence of bone metastases has increased due to improved diagnosis, prolonged survival by adjuvant therapy, and improved follow-up. Osseous metastases of the pelvis are usually diagnosed only late in the course of the disease because of their considerable delayed onset of clinical symptoms. Therefore, treatment is usually focused on a palliative approach to reduce pain and to improve the quality of life. We introduce three patients with bronchial, renal cell, and cholangiocellular carcinoma in an incurable tumor stage with osseous metastases in the pelvis. The metastatic osteolyses caused pain and symptoms of instability. Despite high doses of opiate analgesics, the patients were neither free of pain nor could they be mobilized. The palliative treatment included preoperative tumor embolization followed by tumor resection and implantation of a hip prosthesis. The preoperative embolization reduced intraoperative bleeding and made tumor resection, osteosynthesis, and implantation of the hip prosthesis possible. Mobilization with moderate pain could be achieved in these three patients for the rest of their lives.

Adult↗
PubMed2004

[Principles of callus distraction].

Callus distraction is based on the principle of regenerating bone by continuous distraction of proliferating callus tissue. It has become the standard treatment of significant leg shortening and large bone defects. Due to many problems and complications, exact preoperative planning, operative technique and careful postoperative follow-up are essential. External fixators can be used for all indications of callus distraction. However, due to pin tract infections, pain and loss of mobility caused by soft tissue transfixation, fixators are applied in patients with open growth plates, simultaneous lengthening with continuous deformity corrections, and increased risk of infection. Distraction over an intramedullary nail allows removal of the external fixator at the end of distraction before callus consolidation (monorail method). The intramedullary nail protects newly formed callus tissue and reduces the risk of axial deviation and refractures. Recently developed, fully intramedullary lengthening devices eliminate fixator-associated complications and accelerate return to normal daily activities. This review describes principles of callus distraction, potential complications and their management.

Bony Callus↗
PubMed2003

Outcome assessment after arthrolysis of the elbow.

BACKGROUND: In the literature, the outcome after arthrolysis of the elbow is mainly assessed by range of motion (ROM). Our intention was to verify whether this parameter does sufficiently estimate the outcome after surgical arthrolysis. METHODS: We performed a retrospective study using the validated Disability of the Arm, Shoulder, and Hand Questionnaire (DASH) as our reference outcome parameter. This score was compared with other outcome parameters such as ROM, Mayo Performance Index (MPI) and SF-36. A total of 59 patients who underwent arthrolysis of the elbow was evaluated 53 months after surgery on average. RESULTS: The mean ROM was 101 degrees for flexion/extension with a relative gain of 60% and 134 degrees for pronation/supination with a relative gain of 58%. MPI was 84 points on average. The mean DASH was 17.6 and the mean SF-36 67.9. The correlation of these outcome parameters was calculated using Pearson's correlation (two-tailed, significance set at p<0.05). We found a high correlation between DASH and the physical function part of the SF-36 (Cov=-0.87, p<0.05). The correlation of DASH and MPI was moderate (Cov=0.71, p<0.05) and of DASH and ROM poor (Cov=-0.25, p<0.05). CONCLUSION: ROM as a single parameter does not sufficiently assess the outcome of arthrolysis of the elbow.

Adolescent↗
PubMed2003

[Non-operative treatment of thoracolumbar spinal fractures. Long-term clinical results over 16 years].

Non-operative treatment of thoracolumbar fractures remains the standard treatment option for stable and slightly unstable spinal injuries at the level of the lower thoracic and lumbar spine. The purpose of the present retrospective study was to determine the outcome and long-term results of patients treated conservatively using either one of the two major non-operative treatment modalities: (1) functional, or (2) closed reduction and immobilisation by cast. The average follow-up time for the 43 patients reviewed was 16.3 years. They showed a radiologic increase in the average kyphosis angle of 5.2 degrees compared to the time of injury. No difference was noted between early functional therapy and treatment with closed reduction and immobilisation by cast. Patients with initial neurologic impairment showed a significant improvement ( P<0.05) in their neurologic status during the follow-up period. Results of validated psychometric questionnaires (SF-36, FSR, VAS-Spinescore) showed the characteristic pattern of a population with chronic back pain. In conclusion, a radiologic increase in the traumatic kyphotic deformity in patients with a non-operative treatment protocol has to be expected. Measurable negative physical and social long-term consequences can be anticipated after sustaining a type-A fracture of thoracolumbar vertebral bodies. Any correlation between radiologic and functional results has not been observed.

Adolescent↗
PubMed2003

[Integration of modern technologies in therapy of sarcomas of the pelvis. Computer-assisted hemipelvectomy and implantation of a "custom-made" Bonit gentamycin coated partial pelvic prosthesis].

The resection of primary malignancies in the pelvis is technically demanding as organs and structures are to be preserved and reconstruction of the defect as well as the postoperative function and rehabilitation are dependent on an optimal prosthesis. We present two patients with a sarcoma of the pelvis where for the first time a structured concept of technology integration led to a press-fit implantation of a hemipelvic prosthesis. This concept includes the design and production of a "custom-made" prosthesis as a hemipelvic substitute and the coating of this prosthesis with Bonit, a second-generation calcium phosphate, and gentamycin in watery solution. The tumor resection was done with computer-assisted surgery based on computed tomographies (CT) of the pelvis model done by rapid prototyping rather than on the CT of the patients' pelvis. With this procedure the presurgically simulated resection could be executed precisely with complete resection of the tumors and an accuracy which allowed an exact implantation of the prosthesis. The course was uneventful with primary healing and no sign of an infection or loosening after 6 months.

Bone Neoplasms↗
PubMed2003

Failure of operative treatment in a child with osteoporosis-pseudoglioma syndrome.

A 6-year-old girl with osteoporosis-pseudoglioma syndrome had operative treatment of a distal femur fracture that failed. Osteoporosis-pseudoglioma syndrome is an autosomal recessive syndrome combining severe premature osteoporosis with a bilateral eye disorder leading to early onset of blindness. Beginning in early childhood, the patient sustained multiple fractures of the left distal femur that were treated nonoperatively. At the age of 5 years the patient had a fracture of the left distal femur with an 80 degrees angulation in the sagittal plane. The patient was treated with internal stabilization because of gross bowing of the femur at the fracture site. Intraoperatively, anatomic reduction was achieved by insertion of a flexible nail but not without some intraoperative problems. Because of the severe osteoporosis, iatrogenic penetration and fracture of the femoral cortex by the nail occurred intraoperatively in the subtrochanteric region. In addition, a hip spica cast was applied. The nail was removed 1 week later. After 6 weeks wearing the hip spica cast, the patient's fracture healed with some shortening but with correction of the angulation in the sagittal plane. Internal stabilization seems to be potentially troublesome in patients with severe forms of this syndrome and severe bony deformities.

Biomechanical Phenomena↗
PubMed2002

Complications in surgical treatment of thoracolumbar injuries.

The range of surgical methods for operative treatment of thoracolumbar injuries, with their different ways of approach, grafts and techniques, remains wide. The authors present sources of error and specific complications based on their own experience and on the results of a multicenter study of the Spine Study Group of the German Trauma Association (DGU). A systematic overview of possible mistakes and complications is first presented in anatomical order. A detailed analysis is then presented of the complications reported in a multicenter study, carried out prospectively between 1994 and 1996, on 682 patients operated for acute traumatic injuries of the thoracolumbar spine. In 101 cases (15%) at least one complication occurred intra- or postoperatively. In 41 patients (6%) a revision was performed, and in 60 patients (9%) complications without operative revision were observed. These complications were analysed according to the chosen method of initial treatment.

Humans↗
PubMed2002

Fate of the transpedicular intervertebral bone graft after posterior stabilisation of thoracolumbar fractures.

The authors present a retrospective clinical and radiological study addressing the outcome after posterior stabilisation of thoracolumbar fractures with intervertebral fusion via transpedicular bone grafting. The study included computed tomographic (CT) scan after implant removal for analysis of the intervertebral fusion and incorporation of the intervertebral bone graft and its influence on postoperative re-kyphosing. Twenty-nine patients with acute fractures of the thoracolumbar spine, treated between 1988 and 1995 at the Department of Trauma Surgery, Hannover Medical School, underwent posterior stabilisation and interbody fusion with transpedicular cancellous bone grafting. This study group was followed clinically and radiologically for a mean of 3.5 years. All patients underwent spiral CT scan with sagittal reconstruction after implant removal. Twenty-four type A, four type B, and one type C lesion were posteriorly stabilised and transpedicular intervertebral bone grafting was performed. The operative time averaged 2 h 50 min, the intraoperative fluoroscopy time 4 min 7 s, and the mean intraoperative blood loss was 376 ml. Four patients out of six with an incomplete neurologic lesion (Frankel/ASIA D) improved to Frankel/ASIA grade E. Two complications were observed: one delayed wound healing and one venous thrombosis with secondary pulmonary embolism. Compared to the preoperative status, our follow-up examinations demonstrated permanent social sequelae: the percentage of individuals able to do physical labor was reduced, whereas the proportion of unemployed or retired patients increased. The assessment of complaints and functional outcome with the Hannover Spine Score reflected a significant difference ( P<0.001) between the status before injury (96.6/100 points) and at follow-up (64.4/100 points). The radiographic follow-up revealed a mean loss of correction of 7.8 degrees ( P<0.005). CT scans after implant removal showed an interbody fusion and incorporation of the transpedicular bone graft in ten patients (34%). In another ten patients (34%), the CT scans demonstrated the interbody fusion at the anterior and posterior walls of the vertebral body via direct contact due to collapse of the disc space. In these patients, the bone graft was not incorporated and no central interbody fusion could be found. In nine patients (31%) neither interbody fusion nor incorporation of the transpedicular graft was achieved. A frequent and reliable intervertebral fusion could not be achieved with the described technique of transpedicular bone grafting. The ineffectiveness of the intervertebral graft was found to be a reason for postoperative re-kyphosing.

Adult↗
PubMed2002

[Effect of short-distance spondylodesis of the thoracolumbar transition on neighboring facet joints. A biomechanical study].

This study was performed to investigate the range of motion and the forces on the facet joints that are neighboured to spondylodesis on thoracolumbar spine. We used a special spine testing device for a continuous application of pure moments in each direction. For measuring the ranges of motion we used a magnetic tracking device for measuring forces on facet joints we chose a direct measuring system of quartz crystal and prepared for investigation of the spine. The biomechanical testing was done on 18 human spinal specimen. We investigated the range of motion and the forces on facet joints in T11/12 and L2/3 segment with a maximal loading of 8 Nm in each direction (flexion, extension, lateral bending and rotation). This was done before and after double level dorsal instrumentation T12-L2 with an internal fixateur. Statistical analysis was performed using the paired t-test and the Wilcoxon test (p < 0.05). After double level instrumentation there were significant larger ranges of motion in flexion and extension and significant larger forces on facet joints in left lateral bending in the T11/12 segment. No significant differences were found in the L2/3 segment. Our findings could be an indication for changing in joints loading. This could be an explanation for early degenerative changes in spinal segments adjacent to spondylodesis. The results confirm the demand of short segment instrumentation and early remove of implants to keep influence as low as possible.

Adult↗